Hyperlipidemia, hypertension, and accelerated atherosclerosis are present not only in chronic hemodialysis patients but also in recipients of successful renal transplants. We aim to determine whether an alternate-day corticosteroid regimen reduces the prevalence of these two atherogenic risk factors in comparison with a daily regimen as suggested by our retrospective studies. We are carefully describing plasma lipids in renal transplant candidates and, after successful transplantation, randomly allocating these patients to either a daily or an alternate-day corticosteroid regimen. Plasma lipids and blood pressure are being studied when maintenance immunosuppression is achieved for 1 year. Concurrently, a survey of factors potentially predisposing toward hyperlipidemia is being conducted in renal transplant recipients in a clinic that primarily uses daily steroids and another that uses primarily alternate-day steroids. To define the specific effect of corticosteroid dose spacing on these risk factors, plasma lipids and blood pressure will be serially studied in separate groups of hyperlipidemic or hypertensive renal transplant recipients currently on daily steroids during 6 months of an alternate-day regimen and again after reinstitution of a daily regimen. These studies will demonstrate the effect of corticosteroid dose scheduling on two important atherogenic risk factors and may offer therapeutic alternatives to patients receiving chronic corticosteroid therapy.